Sunday, March 27, 2011

The Vaccine Debate Part 2: With Whom is the Debate and Should We Listen?

The Vaccine Debates Part 2: With Whom Is the Debate?


     As I've been looking more into the vaccination “debate” (I'm using quotes because amongst scientists and physicians there is no debate) I've discovered a wealth of literature. Because I am far from an expert in biochemistry I will not discuss the individual studies that compile the mountains of positive evidence for vaccines but will instead look at general plausibility of anti-vaccination claims.

Who are the Anit-Vaxers and Should we Listen?

     It might be instructive to take a quick look at who the anti-vaccination people are. Just like any group, there are many subgroups but there are some common traits. Some are suckers for the naturalist fallacy, some are anti-government activists, and some have an affinity for conspiracy theories. Most members of this group have a mistrust of what they call the “medical industrial complex”. I will grant that in the context of the profit based US medical system, there is warrant for healthy skepticism when considering the claims of large for profit drug companies and insurance companies. Where I feel the justification for this skepticism breaks down is when we consider the attitudes toward particular health policies of systems that are not profit driven. Consider that every single country that has some form of nationalized/socialized medicine has a national vaccination program. Coincidence? Not only that, but the WHO (World Health Organization) also recommends vaccines and has mountains of research demonstrating their safety (vs. the risk of not vaccinating).
     Lets pause for a second and think. I understand that conspiracy theories are exciting but is it really plausible that every scientist that works for every national healthcare plan and every WHO scientist has been bought out by big pharma to act as their shill? Really? I know what you're thinking...how else can you explain the fact that all these scientists churn out year after year of long term studies demonstrating vaccine efficacy? Um....may I humbly suggest that it might be because the research and its conclusions are valid? Is it really possible that big pharma is paying all these scientists to fudge their research? Lets suppose it's true. Where's the smoking gun? By now at least one disgruntled scientist or spouse of a scientist would have spilled the beans. Ah! I forgot. The media's in on in it too and are covering up the story. Right.
     So, lets say you're still not convinced. You poke your finger in my chest and your logical fallacy detector screeches “Argument from authority! Aruga! Aruga!” You are right to point out that an argument from authority is not a good argument but sometime appeal to authority is valid. The argument from authority as a logical fallacy usually only applies when you only appeal to an individual or a small group of “experts” like, say...appealing to an Andrew Wakefield study.
     When there is broad consensus amongst a field of experts, this is not an argument from authority; it is prevailing wisdom. A quick example: if your car has a problem and you take it to a hundred mechanics and 99 of them say there's a problem with the regulator but 1 says the problem is with the alternator, which are you going to get fixed? Add to that example that the other 99 mechanics say the lone mechanic is a hack. Who would you listen to? Please don't say that “well what if the 99 mechanics are being paid by the regulator industrial complex and the 1 mechanic is fighting the good fight”. I might have to hurt you.
     Lets apply the example to something less controversial (than vaccines, not regulators/alternators) like climate change or evolution. 100% of biologists support evolution and all but one or 2 climate science experts support the idea of anthropogenic climate change. Should we listen to theologists when it comes to evolution? Should we give equal weight to the views of the 1 or 2 dissenting climate scientists? Hopefully not.
     To be sure there is disagreement among the experts about interpretation of the data and the details, just as there are matters that are still unsettled. That's why research is ongoing. But none of these experts in their respective fields would deny the main tenants of the overarching theories: That evolution happened/is happening, that there is anthropogenic climate change and that the benefits of vaccines far outweigh the risks of not being vaccinated.
     Ok, so I know what you're thinking. “Science” has been wrong before, and those in the minority view were eventually vindicated. True. Sometimes it happens. But it takes extraordinary evidence to overturn mountains of confirmatory evidence for an overarching theory. And so far that evidence hasn't materialized. As the skeptics say “extraordinary claims demands extraordinary evidence.”

Next post I'll (finally) write about the basic science surrounding the vaccination question)

Thursday, March 10, 2011

The Vaccine Debate Part 1: The Legal Aspect of the Feb. 22 Ruling

    Because this blog post is likely to attract new readers to my blog, before I get into the meat of the debate I feel some preamble is in order.  Facebook is a wonderful thing.  It allows us to reconnect and stay in contact with friends to a degree that old skool letter writing simply wouldn't allow.  One interesting derivative of facebook is that we can learn how our own views differ from those of our friends and our friends' friends.  As we progress though life we tend to surround ourselves most closely with people who share our own point of view.  Facebook allows us to observe in real time how our views have changed or are diverging from past peer groups.
     So what's my point?  I guess what I'm getting at is that I think having friends/friends of friends who have divergent views from my own allows me to examine my own beliefs more critically.  For example, politically I have what Americans call a "liberal" bias (in Canada I'd be much closer to the centre) but thanks to facebook I can read articles that my more right leaning friends post.  Having access to these articles allows me to see things from a perspective that I probably might not have otherwise.  Sometimes I discount these countervailing views as malarky but occasionally I will agree with some of the points and modify my position.  The most fruitful reaction is when I respond to the article.  Doing so allows me to clarify my own position to myself and determine whether my position is simply an opinion or whether there are strong arguments and/or evidence which support my position.  Sometimes things get heated but as long as my friends and I stay within boundaries appropriate to our friendship/character the outcome is usually fruitful for the both of us.  Basically, this blog entry the the result of one of those interactions.
       As a caveat, I loves me some sarcasm, it's built into my DNA so I urge you not to take too much offence if I am dismissive of any of your cherished beliefs.  I'll do my best to temper it (Ha!) On the bright side I can take just as well as I can dish it...so give me your best!
     Although I'm but a babe in the woods in academia and I have no specialized knowledge, I would argue that training in philosophy qualifies one quite well in the evaluation of arguments.  The subsequent blog post is about several issues in the vaccine debate.  So, what are my medical credentials you ask?  Well, I'm not a doctor, but I did play one for over 2 years with Chippendales.  If that doesn't convince you of my bonifides, I don't know what will.  Without further ado...

Issue 1:  Government "Protection" of Vaccine Producers

    My good friend Nima posted the following article on his facebook page with a subject line that he knew would bate me (we do this to each other....it's fun!)
 Besides the fact that this article is poorly written with grammatical errors and missing words (see ad hominem attack)  there are so many factual fabrications it reads like fox news (see "ad hominem" again!).  Basically I'm having a hard time deciding where to begin.  Lets try this.  I'll summarize the article, point out the main errors, then give some examples of dishonesty in the article.
    The main points of the articles are as follows:  1. Vaccine producers are protected from civil liability should a vaccine cause injury, 2. a)  'mericans are legally compelled to be vaccinated by government b) and that's a violation of FREEDOM! (chant USA! USA! USA!) 3. Vaccines are baaaaad.

Vaccine Producers are Protected from Civil Liability
      First of all the way this claim is made is disingenuous.  Thoughout the article the claim is made that there is "no liability" and "no accountability" for vaccine producers.  The tacit implication that it is very difficult if not impossible for victims of vaccine side effects to receive compensation.  I commend the writer for not outright lying but his account is misleading.  Here are the actual facts:
1.  In 1986 the US government set up the National Childhood Vaccine Injury Act (NCVI) to provide no-fault compensation to those claiming to be victims of vaccines.  So, children suffering from what may be side effects of vaccines have an avenue by which they can receive compensation.  The threshold for a successful claim to demonstrate a causal link is very weak and the effects need only manifest themselves within a reasonable time frame after the injection.  It is important to note that the causal link between most vaccines and the purported side effects is weak at best.
     In many cases, for compensation to be awarded there need only be a temporal causal link between symptoms and vaccination, not physiological or biochemical.  Basically just because event B occurred after event A does not mean that event A caused event B.  I will get into the science of that later.  With the NCVI Children are provided medical, rehabilitation, counselling, and educational expenses in the case of a successful claim.  
Assessment:  While it is true that vaccine producers are protected from civil liability, it is not true that victims have no recourse for compensation.  In defence of the article writer, they never outright say this but any uninformed person reading the article could easily draw this conclusion.

     So how did this whole ruling come about?  Well, basically there was a case in which a family from Pennsylvania went to the NCVI claims committee looking for compensation and didn't get it.  The condition--residual seizure disorder--which afflicted the daughter had been removed from the schedule of approved reactions that qualify for compensation .  In other words,  there was no evidence indicating or plausible mechanism for a causal link between the vaccine and that particular condition.  Despite this, the plaintiff argued that the vaccine company had knowledge of a safer vaccine and if they had distributed the newer vaccine their daughter would not have had the reaction.  The family did not accept the ruling of the NCVI and eventually their case made it to the supreme court.
     In order to understand the supreme court ruling we need to look at the wording of the key passage in the 1986 NCVI law:
     No vaccine manufacturer shall be liable in a civil action for damages arising from a vaccine-related injury or death associated with the administration of a vaccine after October 1, 1988, if the injury or death resulted from side effects that were unavoidable even though the vaccine was properly prepared and was accompanied by proper directions and warnings.
The two keys to the case are the phrase "side effects that were unavoidable" and "the vaccine...was accompanied by proper directions and warnings".  Lets look first at the later.  Before a child gets any vaccine it is the law that the parents read and sign a vaccine information statement (VIS):

A VIS must be given with every vaccination, including each dose in a multi-dose series. Each VIS contains a brief description of the disease, as well as the risks and benefits of the vaccine. Each VIS is developed by the CDC and distributed to state and local health departments as well as individual providers.(my italics, thank you wikipedia)

     Basically this amounts to informed consent. The plaintiff wanted to argue that despite the informed consent the vaccine manufacturer knew about a more attenuated vaccine and should have offered it.
The judges ruled that despite this, the informed consent that was for the vaccine at hand, not another version of the vaccine.  Also, despite what the National Vaccine Information Centre NVIC article states, there are state laws that allow for abstention from taking vaccines.  
    So, the family could have refused that vaccine if the known risks which were on the VIS had been unacceptable to them.  That is to say, the family could have declined having the vaccine administered to their daughter if they were concerned about the "side effects that were unavoidable".  (Actually, in the article the NVIC contradicts themselves because in the first part of the article they say that Americans are legally required to get vaccinated, but at the end of the article they ask for donations to continue their support of existing state laws that allow for exemption--go figure).  
    The supreme court noted that if the law were otherwise interpreted it would open the door for very difficult cases.  Here are a couple of analogies I came up with as thought experiments to illustrate the point:  Let say you buy a car the year before they install airbag technology into the model.  You get into an accident and the injuries you sustained could have been prevented if there had been an airbag in the car.  The car company knew about airbag technology and maybe even sold some of your model with airbags in another country (with less stringent testing regulations, for example).  Can you sue the car company?  They knew about a safer modification to the vehicle.   Or lets say that midway production they started adding airbags.  You bought a car from an early production run that didn't have one.  Does the car company now need to pull all non-airbag (safer) cars from the market and junk them?  
    Here's another that maybe isn't so much of an analogy but a similar case.  Lets say you have a headache and decide to take your usual ibuprofen (NSAID) which can cause stomach ulcers with prolonged frequent use.  Meanwhile just 2 days ago that same drug company just concluded a 5 year FDA trial and received FDA approval for a similar drug but the new one is less likely to cause stomach ulcers.  Is the drug company expected to recall all existing stock of ibuprofen and destroy it just because it has produced on innovation that is slightly safer?  I'm not so sure it has this obligation.  
     If we consider these imperfect analogies we can see how it would be difficult for the court to rule in favour of the plaintiff and the difficulties that would arise out of setting such a legal precedent.  The bottom line however is that all this legal stuff is secondary to the science.  The science does not support any causal link between the DTP vaccine and many of the claimed side effects. (Again, I will discuss the science in part 2 which I hope to write over the weekend)
     Anyway, hopefully this fosters some perspicuity on how the ruling came about and why the supreme court ruled the way it did.  One final note.  At this point any careful reader should notice what seems to be a logical inconsistency in my position.  On the one hand I am implying that vaccines are safe but on the other I am saying that there is the NCVI which provides compensation for those experiencing side effects.  If vaccines are so safe why should there be a body which decides on compensation for side effects?  Ah! ha! good question.  I will elaborate on this when I discuss the science of vaccines.

Why Protect Vaccination Producers?
     Although the issues surrounding this particular case are interesting, the more important issue is why the US enacted the NCVI law in 1986 in the first place.  Why should government (once again) protect big bad pharma?  Before I continue I'd like to clarify that I do not think that pharmaceutical companies are particularly ethical actors.  In fact, there are many instances where they have proven to be quite the opposite.  Despite this there are important reasons for which the NCVI law was enacted.

A little background which I have stolen from this article 
I'll summarize for those of you who are already bored with the topic and don't wish to do any further reading:
In 1982 NBC produced an "expose" of alleged DTP vaccine related injuries.  This began the first major anti-vaccination movement and proliferation of misinformation.  
While in 1979 there was only 1 DTP-related lawsuit, by 1986 there were 255, with a total of over $3 billion sought by claimants. This clearly was not sustainable for the vaccine industry, and in fact manufacturers went out of business. In 1967 there were 26 US manufacturers of vaccines. By 1980 this number had dropped to 15, and by 1986 there were only 3 companies still making vaccines in this country. Vaccine prices skyrocketed, and manufacturers found it difficult to obtain liability insurance.

Basically, the sheer legal costs of defending claims made doing business prohibitive. The alternative was for pharmaceutical companies to stop producing vaccines. I know if I were selling vaccines in that environment I'd close my doors too and stick to selling aspirin.  What rational business person wouldn't?  So, it seems that the CDC and related government agencies were faced with a decision:  offer some protection to vaccine producers, or eliminate the vaccine program all together.  
     Now I know what your thinking.  They should have eliminated the vaccine program.  If people would just think more positive thoughts they wouldn't get sick.  All sickness comes from either negative (quantum?) energy, stress, and poor access to triple rainbows.  I know! But you're preaching to the choir.  All this crap about genetic predispositions, viruses, bacterial infection, different diseases having different aetiologies and pathologies... can all be avoided by simply tapping into the universe's positive energy.  And if you should accidentally unplug yourself from the positive waves of quantum energy, easy solutions are just around the corner.  Got mumps?  Laugh away those bumps....homeopathy will fix it!  Got polio? Just look at my portfolio...super doses of vitamins will have you healthy in no time!  Problem with your spleen?  Easiest thing I've ever seen...Reflexology will do the trick, just massage your foot where it's thick!  I've got hundreds of these folks, but I'll spare you--you get my point.
      I know it sucks to give legal protection to big corporations (and I'm actually being serious here) but I think in this particular instance it is warranted.  

OK folks, what was supposed to be a quick overview of the vaccine issues sprinkled with witty remarks has turned into a full-blown research project.  I have to work over the next few days but over the weekend I'll try to produce a part 2 focusing on the research/science.  Please post your comments and hate mail!

Thursday, March 3, 2011

Thoughts on "Waiting for Superman"

      I just finished watching "Waiting for Superman" and decided I'd write a couple of my thoughts.  My first thought was "how did I ever survive growing up in the ghettos of Dunbar?" (note for my international readers, that's a middle-class neighbourhood in Vancouver.  It's a joke you see... because it's not a bad neighbourhood, and as the more I explain the joke, the funnier it will get!)
      Actually one of my first thoughts was, how did I manage to avoid all those horrible teachers the film talks about?  I'm sure I had some teachers that weren't spectacular and I was a very average student up until grade 10 when I decided to take things a little more seriously.  Actually, my Dad told me I couldn't play any sports until I showed that I could maintain a "B" average.  I went from a lifetime "C" student to "B" student in a month.  Did my teachers all of a sudden get better?
    I have a thought here but I'm having trouble deciding how to express it...  I guess it's that while I certainly agree with the thesis of the film that great teachers can make a difference, students also need to be self-motivated.  I remember lots of classes where I would walk out of the class (especially math, sometimes physics) and have no clue what we just did for an hour but I'd go home, read the examples in the textbook and do the problem sets, and eventually after some serious mental anguish I'd get it.  Of course sometimes I wouldn't be able to do it and I'd call a classmate for help but more often than not I'd struggle with it until I figured it out.  So, part of what I'm trying to say is that while it's fine and dandy to point the finger at teachers, learning takes effort.  The teacher cannot learn for you.  
     STOP! I just had a revelation:  I'm old.  Ya know how I know?  Cuz in this next paragraph I'm going to bemoan "kids these days".  Seriously, kids these days want everything to come easy.  Everything is too hard.  Boohoo.  It seems everywhere I look, this is the attitude of the times.  Can I say the zeitgeist of the times?  I like that phrase and don't get to use it often enough...It seems the kids want all the success and wealth with none of the sacrifice and hard work.  They only want to do what they like to do when they want to do it.  Ok, I know it's not every kid but I seem to encounter this attitude a lot.
     This kind of leads to my next point about the movie which is they don't ask what are the 20 something other countries' education systems that are out-competing the US doing differently?  Well, as someone who has taught high school kids in Japan I can tell you that the difference does not lie in the quality of the teaching.  In fact, given my experience teaching in Japan, (and I'm sure anyone else who's taught in Japan can back me up on this) if we extend the "it's the teachers' fault hypothesis" to Japan I'd say it's a freakin' miracle Japanese kids can tie their shoelaces.  Oh! Little Johnny can't learn because his teacher doesn't make learning FUN! He doesn't encourage him enough!  Really!?  Try sitting in a Japanese high school class.  Johnny's class will seem like a field trip to Disneyland with all the candy he can eat with his own cheer-leading squad (Mmm...cheerleading squad......)  
      You know why the other countries are out-perfoming US students? As a world renowned expert I will tell you:  1.  The students do their freakin' homework;  2.  Those societies still show some modicum of respect for teachers so when a teacher disciplines a child, the parent backs up the teacher not the student; 3.  It's not "cool" to be a failure and/or ignorant in those countries;  4.  The culture values education (unlike the US where science is chased out of the classrooms in place of religious superstition) 5.  Again, the teachers know that the parents back them 100% so if a kid is being disrespectful/not doing their work the teacher can enforce discipline rather than what happens here, i.e. the parent thinks their kid is perfect and how dare the teacher be "mean" to their child.  6.  The kids are expected to work hard and do well.  7.  The teacher is not expected to be a cheerleader for the kids, praising them for every minor thing they do well.  Here's a wacky idea...you're supposed to do your homework and do well in school--that's the norm!  Why should we praise people for achieving the norm?
    Despite all the reasons why these other countries are out-performing the US, US culture is not going to become like Japan's.  The film makers are correct to say changes need to be made in how education is carried out in the US, especially in the inner cities.  We're going to have to accept that maybe the teachers will have to act as cheerleaders and will have to make leaning "fun".  The fact of the matter is that what works in one culture might not work in another and that current educational policies aren't working.   We (or just me, I'm fine with that) can blame the kids until we're blue in the face but it's actually the adults that failed them long ago.   ...the children! save the children! (I probably shouldn't make light of these things but how can I pass up an opportunity to use a cliche)
     One important idea that emerged from the film was that teachers' unions are a major part of the problem.  This relates back to how I started this post, wondering how it is that I magically by passed all the "lemon" teachers.  It could be that in Canada the education system and socio-economic circumstances are quite different, or at least they are at the 1 elementary and 3 high schools I went to.  I find it hard to believe that the amount of crappy teachers out there is so great as to so greatly negatively effect the level of education.  Were there no crappy teachers in the US in the 1950s, 60s, and 70s when the US was leading the world in education?  
     Also, the amount of education required for someone to be a teacher now is significantly greater than what it was back in the golden age of US education.  Tonnes of research has been carried out on effective methods, which teachers learn as part of teacher training.  So, how can poor teaching be such a problem if teacher now has at least 2 extra years of education specific to teaching methods?  It just doesn't add up.  The film hinted at one possible explanation, which was that the US did so well comparatively because the other nations didn't have education systems to speak of.  Ok, that would make sense but when you compare 1960s US metrics to current US metrics,  the 1960 students performed much better.  Did all the extra teacher training lead to crappier teaching?  Unlikely.
    Getting back to the crappy teacher hypothesis, I felt that there was a compelling argument for at least reducing the facility with which teachers attain tenure and for allowing better performers to be better paid.  To be sure there are problems with changing these things but I think some flexibility on the part of the teachers union might be helpful--if a teacher has been proven to suck definitively he should be fired just like in any other job.  
     Regarding granting tenure to teachers after only 2 years, when compared to what university professors have to go through it seems a bit easy.  A university professor must endure on average 10 years of post secondary education, writing, researching, and publishing articles (for free), and working on committees (for free).  At the end of it all there is not guarantee of tenure.  I do however feel that tenure is important because if someone is going to invest 5 or 6 years of their life getting an education for a career path that pays very little, they deserve a little security.   How else are we going to attract any talent?  Also, it is very easy to imagine a situation in the US and A where a good biology teacher in the South wants to teach evolution but can't because he knows he'll get chased out of town with torches and pitchforks.  
     Furthermore, there will be complications with performance based pay because the demographics of your school have a significant effect on student abilities/behavioural problems/parent support/etc...  Nevertheless, I don't think these problems are irresolvable and remember we are doing it for the children! How can you argue with that?
     All this bickering of educational policy and methodology...tsk tsk.   The solution is sooooooo simple.  Haven't you read "The Power of Now" or "The Secret"?  These kids are failing because they are not willing the universe hard enough to give them "A"s.  Clearly, they and their parents just don't want it badly enough.  It's all their fault.  Those silly inner city kids.  If they just wanted it badly enough the universe would conspire to give them A's.  To quote Hansel, "it's so simple".

Anyway, I'd love to hear what other people think about this...